Score for Neonatal Acute Physiology: A Physiologic Severity Index for Neonatal Intensive Care

PEDIATRICS ◽  
1993 ◽  
Vol 91 (3) ◽  
pp. 617-623 ◽  
Author(s):  
Douglas K. Richardson ◽  
James E. Gray ◽  
Marie C. McCormick ◽  
Kathryn Workman ◽  
Donald A. Goldmann
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Mortality Risk ◽  
Neonatal Intensive Care ◽  
Severity Index ◽  
Illness Severity ◽  
Neonatal Intensive Care Units ◽  
Nursing Workload ◽  
Substantial Variation ◽  
Therapeutic Intensity

The substantial variation in birth weight-adjusted mortality among neonatal intensive care units (NICUs) may reflect differences in population illness severity. Development of an illness severity measure is essential for comparisons of outcomes. The Score for Neonatal Acute Physiology (SNAP) was developed and validated prospectively on 1643 admissions (114 deaths) in three NICUs. SNAP scores the worst physiologic derangements in each organ system in the first 24 hours. SNAP showed little correlation with birth weight and was highly predictive of neonatal mortality even within narrow birth weight strata. It was capable of separating patients into groups with 2 to 20 times higher mortality risk. It also correlated highly with other indicators of severity including nursing workload (r = .59), therapeutic intensity (r = .78), physician estimates of mortality risk (r = .65), and length of stay (R2 = .59). SNAP is an important new tool for NICU research.

Device-associated pneumonia of very low birth weight infants in Polish Neonatal Intensive Care Units

2016 ◽  
Vol 61 (1) ◽  
pp. 90-95 ◽  
Author(s):  
Jadwiga Wójkowska-Mach ◽  
T. Allen Merritt ◽  
Maria Borszewska-Kornacka ◽  
Joanna Domańska ◽  
Ewa Gulczyńska ◽  
...  
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Neonatal Intensive Care Units ◽  
Low Birth Weight Infants

Score for Neonatal Acute Physiology: Validation in Three Kaiser Permanente Neonatal Intensive Care Units

PEDIATRICS ◽  
1995 ◽  
Vol 96 (5) ◽  
pp. 918-922 ◽  
Author(s):  
Gabriel J. Escobar ◽  
Allen Fischer ◽  
De Kun Li ◽  
Robert Kremers ◽  
Mary Anne Armstrong
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Hospital Mortality ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Severity Of Illness ◽  
Predictive Ability ◽  
Neonatal Intensive Care Units ◽  
Total Hospital ◽  
Total Hospital Stay

Background. Measurement of the severity of illness is a research area of growing importance in neonatal intensive care. Most severity of illness scales have been developed in tertiary care settings. Their applicability in community neonatal intensive care units has not been tested. Objectives. Our goal was to assess the operational characteristics of the score for neonatal acute physiology (SNAP): the relationship to birth weight, the length of total hospital stay, and in-hospital mortality. Methods. We assigned SNAP scores prospectively to all inborn admissions at three community neonatal intensive care units during an 11-month period. Data on other neonatal predictors (eg, birth weight and the presence of congenital heart disease) were also collected. We measured in-hospital mortality, the experience of interhospital transport to a higher level of care, and total hospital stay. Results. We found that the SNAP's relationship to birth weight was similar to previous reports. The SNAP's perinatal extension is a reliable predictor of newborn in-hospital mortality, with an area under the receiver operator characteristic curve of 0.95. The SNAP is also a good predictor of total hospital length of stay, whether by itself (by which it can explain 31% of the total stay) or in combination with other variables. Its predictive ability is better among infants of low birth weight (<2500 g) than among those of normal birth weight (≥2500 g). The SNAP's predictive power was most limited among infants admitted to rule out sepsis. The predictive ability of a model containing birth weight, the SNAP, and transport status was not improved by the inclusion of two major diagnostic categories, the presence of congenital heart disease or complex illness. Conclusion. Although it has definite limitations among infants who weigh 2500 g or more, the SNAP is a potent tool for outcomes research. Modification of some of its parameters could result in a multifunctional scale suitable for use with all birth weights.

Morbidity and Mortality Among Low Birth Weight Infants Exposed to an Intravenous Vitamin E Product, E-Ferol

PEDIATRICS ◽  
1989 ◽  
Vol 83 (2) ◽  
pp. 244-249
Author(s):  
Janet B. Arrowsmith ◽  
Gerald A. Faich ◽  
Dianne K. Tomita ◽  
Joel N. Kuritsky ◽  
Franz W. Rosa
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Vitamin E ◽  
Low Birth Weight ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Morbidity And Mortality ◽  
Neonatal Intensive Care Units ◽  
Low Birth Weight Infants ◽  
Intravenous Vitamin

In April 1984, the US FDA was notified of an unusual clinical syndrome consisting of ascites, liver and renal failure, thrombocytopenia, and death among low birth weight infants exposed to an intravenous vitamin E preparation, E-Ferol. The product, which had not been tested for safety prior to marketing, was voluntarily withdrawn from the market in early April. To further investigate the reported associations, the FDA conducted a retrospective cohort study among seven neonatal intensive care units where the product had been used. Standardized abstraction forms were completed for infants admitted to a unit between Nov 1, 1983, and April 30, 1984. Included in the study were 379 infants weighing 2,000 g or less and surviving at least two days; 148 (39%) had been exposed to E-Ferol. Compared with the unexposed infants, the exposed infants were more likely to die and to have ascites, hepatomegaly, thrombocytopenia, and a combination of clinical events similar to the syndrome initially reported. We conclude that the use of E-Ferol in these neonatal intensive care units was associated with increased morbidity and mortality among exposed infants.

Coagulase-Negative Staphylococcal Bacteremia Among Very Low Birth Weight Infants: Relation to Admission Illness Severity, Resource Use, and Outcome

PEDIATRICS ◽  
1995 ◽  
Vol 95 (2) ◽  
pp. 225-230 ◽  
Author(s):  
James E. Gray ◽  
Douglas K. Richardson ◽  
Marie C. McCormick ◽  
Donald A. Goldmann
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Resource Use ◽  
Cumulative Incidence ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Illness Severity ◽  
Incidence Density ◽  
Low Birth Weight Infants

Objective. To examine the impact of admission-day illness severity on nosocomial bacteremia risk after consideration of traditional risk determinants such as birth weight and length of stay. Methods. The hospital courses for 302 consecutive very low birth weight (less than 1500 g) infants admitted to two neonatal intensive care units were examined for the occurrence of nosocomial coagulase-negative staphylococcal bacteremia. Using both cumulative incidence and incidence density as measures of bacteremia risk, we explored the relation between illness severity (as measured by the Score for Neonatal Acute Physiology [SNAP]) and bacteremia both before and after birth weight adjustment. In addition, the effect of bacteremia on hospital resource use was estimated. Results. Coagulase-negative staphylococcus was the most common pathogen noted in blood cultures drawn at 48 hours after admission or later. It was isolated on at least one occasion in 53 patients (cumulative incidence of 17.5 first episodes per 100 patients). These episodes occurred during 7652 days at risk, giving an incidence density of 6.9 initial bacteremias per 1000 patient-days at risk. As expected, when compared with the nonbacteremic group, bacteremic patients were of lower birth weight (888 ± 231 vs 1127 ± 258 g; P < .01) and gestational age (26.4 ± 2.1 vs 28.9 ± 2.8 weeks; P < .01). In addition, these patients were more severely ill on admission (SNAP 17.3 ± 6.5 vs 12.2 ± 5.8; P < .01). Even after birth weight stratification, the risk of bacteremia by both measures increased with higher SNAP scores. For example, among infants with birth weights greater than 1 kg, 25% of the most severely ill patients (SNAP 20 and higher) experienced at least one bacteremic episode, whereas the rates seen in infants with intermediate (SNAP 10 to 19) and low illness severity (SNAP 0 to 9) were 8.6% and 3.0%, respectively (χ2 for trend = 7.25; P < .01). Multivariate linear regression showed that bacteremia was associated with a prolongation of neonatal intensive care unit stay of 14.0 ± 4.0 days (P < .01) and an increase in hospital charges of $25 090 ± 12 051 (P < .05), even after adjustment for birth weight and admission-day SNAP. Conclusions. Nosocomial coagulase-negative bacteremia is an important complication among very low birth weight infants. Assessment of illness severity with SNAP provides information regarding nosocomial infection risk beyond that available from birth weight alone.

Holding the Very Low Birth Weight Infant: Skin-to-Skin Techniques

2005 ◽  
Vol 24 (1) ◽  
pp. 7-14 ◽  
Author(s):  
Theresa Kledzik
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Intensive Care Units ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Neonatal Intensive Care Units ◽  
Low Birth Weight Infant ◽  
Skin To Skin

Skin-to-skin holding has been reported as a valuable intervention for preterm infants for over a decade. However, many neonatal intensive care units are not practicing this therapy and cite lack of protocols and techniques as a barrier. This article describes in detail the nursing considerations and techniques involved to successfully implement skin-to-skin holding for very low birth weight, technology-dependent infants. NICU protocols can be derived from this article.

scholarly journals Critérios clínicos e insumos utilizados no banho de recém-nascidos pré-termo de muito baixo peso

2020 ◽  
Vol 11 (2) ◽  
Author(s):  
Samara Cecilia Sabino Pereira Da silva ◽  
Elizandra Cassia Da Silva Oliveira ◽  
Ana Virginia Rodrigues Verissimo ◽  
Katia Maria Mendes ◽  
Regina Celia De Oliveira
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Tap Water ◽  
Neonatal Intensive Care Units ◽  
Clinical Criteria ◽  
Terapia Intensiva

Objetivo: identificar os critérios clínicos e insumos utilizados para a administração do primeiro banho em recém-nascido prematuro de muito baixo peso internado em unidades de terapia intensiva neonatal.Métodos: estudo descritivo, com abordagem quantitativa. Com base no Método Canguru/Ministério da saúde, realizado em cinco unidades de terapia intensiva neonatal; população composta por 82 profissionais da equipe de enfermagem. Resultados: os critérios clínicos não apontados na avaliação foram 19,5% para a saturação de oxigênio, 23,2% frequência cardíaca e 29,3% frequência respiratória. Os insumos utilizados na realização do primeiro banho: água de torneira aquecida 56,1%, com controle bacteriológico 52,4%, sabão líquido 89,0%, com pH neutro em 76,8%. Conclusão: a não observância dos sinais clínicos e os insumos inadequados para a realização do banho do recém-nascido prematuro de muito baixo peso pode colocar em risco a segurança do paciente; emergindo adequações para fortalecimento da prática clínica da enfermagem.Descritores: Recém-Nascido de Muito Baixo Peso; Unidades de Terapia Intensiva Neonatal; Enfermagem Neonatal; Banhos. Objective: To identify the clinical criteria and inputs used for the administration of the first bath in a very low birth weight premature newborns in neonatal intensive care units. Methods: descriptive study, with a quantitative approach based on the Kangaroo/Ministry of Health Method, carried out in five neonatal intensive care units; population composed of 82 professionals from the nursing team. Results: The clinical criteria not mentioned in the evaluation were 19.5% for oxygen saturation, 23.2% heart rate and 29.3% respiratory rate. The inputs used in the first bath: heated tap water (56.1%), with bacteriological control (52.4%), liquid soap (89.0%), with neutral pH (76.8%). Conclusion: Failure to observe clinical signs and inadequate supplies for bathing the very low birth weight premature newborn can put patient safety at risk; emerging adaptations to strengthen clinical nursing practice.Descriptors: Infant, Very Low Weight; Neonatal Intensive Care Units; Neonatal Nursing; Baths. Objetivo: Identificar los criterios clínicos y los insumos utilizados para la administración del primer baño en recién nacidos prematuros de muy bajo peso al nacer en unidades de cuidados intensivos neonatales. Métodos: Estudio descriptivo, con enfoque cuantitativo, basado en el Método Canguro/Ministerio de Salud, realizado en cinco unidades de cuidados intensivos neonatales; población compuesta por 82 profesionales del equipo de enfermería. Resultados: Los criterios clínicos no mencionados en la evaluación fueron 19.5% para la saturación de oxígeno, 23.2% de frecuencia cardíaca y 29.3% de frecuencia respiratoria. Los insumos utilizados en el primer baño: agua caliente del grifo (56.1%), con control bacteriológico (52.4%), jabón líquido (89.0%), con pH neutro (76.8%). Conclusión: El incumplimiento de los signos clínicos y los suministros inadecuados para bañar al recién nacido prematuro de muy bajo peso pueden poner en riesgo la seguridad del paciente; adaptaciones emergentes para fortalecer la práctica clínica de enfermería.Descriptores: Infantil, Muy Bajo Peso; Unidades de Cuidados Intensivos Neonatales; Enfermería Neonatal; Baños.

scholarly journals Clinical Profile of Neonatal Hypoglycaemia in a Tertiary Care Centre in Mahabubnagar, Telangana

2021 ◽  
Vol 8 (35) ◽  
pp. 3241-3246
Author(s):  
Nagaveni Patta ◽  
Manthena Jagadeesh Kumar ◽  
Mohd Sirazuddin
Keyword(s):  
Intensive Care ◽  
Blood Glucose ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Glucose Monitoring ◽  
Neonatal Intensive Care Units ◽  
Neonatal Hypoglycaemia ◽  
Time Of Admission

BACKGROUND Hypoglycaemia is one of the most common metabolic problems seen in neonatal intensive care units (NICU). Most cases of neonatal hypoglycaemia are transient and respond readily to treatment and are associated with excellent prognosis. Development of clinical signs and symptoms may be a late sign of hypoglycaemia. Persistent hypoglycaemia may result in possible neurologic sequelae. The purpose of this study was to assess the clinical pattern of hypoglycaemia in neonates admitted in special newborn care unit in Government General hospital, Mahabubnagar, Telangana and to also assess the influence of gestational age, birth weight, various comorbid conditions on blood glucose levels. METHODS This is an observational hospital-based study done in Government General Hospital, Mahabubnagar from June 2020 to May 2021. Neonates with hypoglycaemia (blood glucose < 45 mg/dl) at the time of admission are included in our study. Blood glucose values were monitored 2nd hourly on 1st day and 6th hourly thereafter. Following the detection of hypoglycaemia, the neonates were treated as per institutional protocol. Clinical features, laboratory parameters are studied and analysed. RESULTS Among the 99 neonates studied, 68 (68.7 %) were males and 31 (31.3 %) females; Term babies were 75 (75.7 %) and pre term babies were 24 (24.2 %). Low birth weight newborns (51.5 %) were more affected with hypoglycaemia compared to normal weight newborns (38.4 %). Among the 99 neonates studied, 96.9 % were treated and discharged. Average duration of stay was around 05 to 07 days. CONCLUSIONS Hypoglycaemia is most common condition in neonates. Routine screening should be done to all newborns at the time of admission. Timely intervention reduces long term neurological sequelae. Neonates presenting with dull activity, refusal to feed, vomiting, jitteriness, seizures must routinely undergo regular glucose monitoring. As the study shows, most hypoglycaemic neonates presented with those symptoms. Among the various comorbidities, hypoglycaemia occurred more in birth asphyxia and respiratory distress syndrome. So, it should be made mandatory to do glucose monitoring in these cases. Glucose monitoring should be made as a common screening method to prevent morbidity and mortality in neonatal intensive care units. KEYWORDS Hypoglycaemia, Pre-Term, Term, Low Birth Weight, Special New Born Care Unit, Small for Gestational Age, Large for Gestational Age

Sign in / Sign up

Export Citation Format

Share Document